black toes

ok....I work in LTC On a friday I told the staff to get the patient to the hospital, or call the doctor due to his "black toes" were no longer hard and black. they were "wet and black" we know what that means. they said ok...we will do that. I left thinking they were on the phone due to they were talking to someone about the patient. I was gone the next week because I am currently in the clinical portion of obtaining my WOCN so I was gone all week. I came back on tuesday...the patient is still there...now you see bone...the patient is so confused he is walking into patients rooms and actually crawling into their beds! So the staff said the bone was not noticed until that day i came back. but the black was "wet, spongy...not hard anymore I told them. they had "faxed" the doctor. He ordered labs.

well I sent him out to ED yesterday...they will now have to perform a BKA. this poor guy is 90 already! but they I believe should of done something way before...? I am not sure...like I said I am still in the process of learning.

what do you do usually for necrotic dry toes? he had arterial disease. and then once you see they are "wet".....what do you do?

I am very glad this LTC has hired me due to a lot has changed already due to what I have learned! its great and I love seeing the results. but what should i have done? and what should I do in the future. I called and talked to the doctor, and he states we did things correctly...even though I think we should of sent him a week before. ?????

i am on your side, i think this is medical and nursing neglect!

Hey,

Sorry about your patient sound like a wee bit of a mess

It depends on the patient as to what you would do. If his goal is healing then I would have ordered new vascular studies, TCOM, and labs that have to include albumin, pre-albumin, CRP, and ESR to start. It's pro active wound care initial assessment. When toes are black and hard, they usually require daily protective dressing until they declare themselves. When you have open areas and drainage, get cultures and treat empirically. The ideal dressing for this wound be Iodasorb with q2-3 day and PRN changes. If the patient is not wanting to treat aggresively, I would concentrate on pain managment, and still do the Iodasorb, with maybe some 4% LMX if needed. The labs etc. would be moot. I cannot tell you how many walls you're going hit with the primary nursing staff with wound issues. They have no clue what they're looking at, which is why you, as the wound care expert has to be proactive. Also you may have to have a care plan meeting with the family to find out in what direction they want to go.

Wound care is expensive, and hard on your patient. Are they eating? Underlying med. hx.? Infectious process?? It goes on and on. Age and confusion are both huge barriers to healing, with any foot/toe wound you will usually write an order for non-wt. bearing, but with a confused patient..Good luck with that one.

Anyway, I hope maybe this helps a little, and best of luck with your WOCN